Physiology

Vitamin K dependent coagulation factors includes factors IX and X.

During heavy exercise cardiac output (CO) increases upto 5 times while pulmonary arterial pressure rises very little. This physiological ability of the pulmonary circulation is best explained by increase in number of open capillaries.

Venous return to heart during quiet standing is facilitated by Calf muscles contraction during standing, Valves in perforators and sleeves of deep fascia.

During cardiac imaging the phase of minimum motion of heart is mid diastole.

VLDL, LDL and HDL moves towards charges end in electrophoresis but Chylomicrons do not.

Method of chromatography where molecules that are negatively charged are selectively released from stationary phase into the positively charged molecules in mobile phase is termed Ion exchange chromatography.

Rothera’s test is used for detection of Ketones.

Predominantly mitochondrial liver enzyme is SGOT (AST).

Microarray is used for detection of variation in DNA sequence and Gene expression.

FISH, RT-PCR and QF-PCR are used for detection of specific aneuploidy.

Most characteristic ultrastructural features of paraganglioma on electron microscopy is dense core neuroendocrine granules.

CD 1a is a marker for Langerhans cell histiocytosis.

Down’s syndrome is most commonly caused by Maternal nondisjunction.

A normal couple with 1 daughter affected with autosomal recessive disease. Chances of sibling being affected by the disease is 1/4.

Males are more commonly affected than women in X-linked recessive diseases.

Microbiology

Peptide binding site on class 1 MHC molecules for presenting processed antigens to CD8 T cells is formed by Distal domain of alpha subunit.

Penicillin binding proteins (PBP 0 are essential for cell wall synthesis, they act as carboxypeptidases and transpeptidases and alteration in PBP’s is the primary bases of resistance in MRSA.

In penicillin resistance Beta lactamase production is the most common mechanism of resistance, alteration in permeability/ penetration of antibiotic causes resistance only in Gram negative bacteria and beta lactamase production causes resistance in both gram positive and gram negative bacteria.

About 30% of general population is healthy nasal carriers, epidermolysis and TSS toxin are superantigens and methicillin resistance is chromosomally mediated.

Planning of intervention by community best reflects the highest level of community participation.

Maternal mortality rate (MMR) has numerator that includes total number of women deaths within 42 day’s of delivery, it is expressed as a rate and not a ratio and it is expressed per 100000.

Perinatal mortality rate includes stillborns and death within 7 days of birth.

IMNCI differs from IMCI in that malaria and anemia are included in it, 0-7 days neonates are included and emphasis on management of sick neonates over sick older children.

Mass chemoprophylaxis in endemic area is recommended for Yaws, Trachoma and Filaria.

Rural and urban difference in prevalence is seen in lung cancer, TB and chronic bronchitis.

For tuberculosis Annual Rate of Infection (ARI0, he average estimated ARI for India is 1.7%, AIRI reflects the current trend and effectiveness o control measures and ARI represents the percentage new infections.

Scrub typhus is caused by O. tsutsugamushi, mites act as reservoir and tetracycline is the drug of choice.

Factors contributing to resurgence of malaria includes drug resistance in parasite, drug resistance in vectors and antigenic variation in parasite.

A case of acute flaccid paralysis must be observed for 60 days for residual weakness.

Indian aims to eliminate Filariasis by 2015.

Screening strategy for prevention of blindness from diabetic retinopathy according to NPCB involves high risk screening.

95% confidence interval will cover 2 standard errors around the mean.

A standard Z-score is related to normal distribution.

For a new test for diabetes, 80 people tested positive out of which only 40 had diabetes and out of 9920 people who were tested negative only 9840 did not have disease. Sensitivity of this new test is 33%.

Population on 1st June was 1, 65,000, Total number of new cases of TB from 1st-31st June were 22. Total registered cases of TB in community were recorded as 220. Incidence of TB in this community per 10 lakh population is 133.

In Red Cross emblem size of bars in the cross is equal horizontally and vertically, misuse of emblem is punishable offense under Indian law and was convened in Geneva.

29-year-old anxious woman with h/o progressive breathlessness and exercise intolerance since 4 months. Her FVC is 90% and FEV1/FVC is 86%. Oxygen saturation after exercise was observed to drop from 92% to 86%. Likely diagnosis is Primary pulmonary hypertension.

Young girl with abdominal pain, recent change in bowel habit with passage of mucus in stool. No associated blood in stool and symptoms are increased with stress. Most likely diagnosis is Irritable bowel syndrome.

Elderly patient with prolonged h/o weakness and lethargy, he is anemic and stool is positive for occult blood. Investigation of choice is Colonoscopy.

Woman with stab injury to left side of abdomen, hemodynamically stable, CECT reveals laceration in spleen. Laparoscopy was patient’s pO2 suddenly dropped as soon as pneumoperitoneum was created. Most likely cause is Gaseous embolism through splenic vessels.

Grading method is used to evaluate prognosis/ outcome after subarachnoid hemorrhage is Hess and Hunt scale.

Pediatrics

Health status of a child under 5 years of age will be adversely affected by malnutrition, low birth weight and infections.

Neonate presented with fever, lethargy, abdominal distension, vomiting and constipation. He was diagnosed as volvulus neonatorum with suspected perforation. Best investigation would be plain X-ray.

10-year-old with seizures, BP 200/140 mm Hg and femoral pulses not palpable. Most likely diagnosis is Coarctation of Aorta.

7-year-old asymptomatic girl is found to have persistent hypertension, no significant history and urine examination normal. Most likely cause is Renal parenchymal disease.

Child presented with intermittent episodes of left sided flank pain, USG reveals large hydronephrosis with dilated renal pelvis and cortical thinning with a normal ureter, kidney differential function was observed to be 19% then best management is Pyeloplasty.

Child with hepatomegaly, hypoglycemia and no improvement in blood sugar even after administration of epinephrine. Likely diagnosis is Von Gierke’s disease.

Factors associated with a substantially greater risk of developing epilepsy after febrile seizures includes complex febrile seizures, developmental abnormalities and positive family history of epilepsy.

Child presents with short episodes of vacant stare several times a day which begins abruptly and child remains unresponsive during episode, no associated history of aura or postictal confusion and child is otherwise normal. Likely diagnosis is Absence seizures.

Drugs used in Juvenile Myoclonic Epilepsy (JME) includes Topiramate, Zonisamide and Valproate.

Obstetrics and Gynaecology

Primary amenorrhea with normal ovaries, normal external genitalia and normal;l breasts is seen in Mayer-Rokitansky-Kuster-Hauser syndrome.

Condition presenting with absence of both Mullerian and Wolffian duct structures is Androgen insensitivity syndrome.

Woman with secondary amenorrhea 6 months after having an abortion with FSH 6 mIU/ml. Most probable diagnosis is uterine synechiae.

Agent most commonly associated with carcinoma of cervix is HPV 16.

40-year-old woman with abnormal cervical cytology on Pap smear suggestive of CIN III (HSIL). Next best step of management is Colposcopy and LEEP.

Sentinel lymph node biopsy is most useful for Carcinoma of vulva.

52-year-old woman with constant leakage of urine and dysuria 2 weeks after complicated total abdominal hysterectomy. Diagnosis of Vesicovaginal fistula is suspected which can be confirmed by Triple swab test.

52-year-old woman with vesicovaginal fistula after abdominal hysterectomy is not responding to conservative management. Most important investigation is Cystoscopy.

Partial mole is usually associated with Triploidy, it rarely causes persistent gestational trophoblastic neoplasia and usually present as missed abortions.

Conversion of a complete hydatidiform into invasive mole is indicated by Plateau HCG, enlarged uterine size and suburethral nodule.

Treatment of choice for intrahepatic cholestasis in pregnancy is ursodiol (ursodeoxycholic acid).

Cardiac contraindications to pregnancy includes Eisenmenger’s syndrome, pulmonary hypertension and coarctation of aorta.

DOC to treat Chlamydia infection in pregnancy is Azithromycin.

Cleft palate is associated with polyhydramnios.

Lady presented with features of threatened abortion at 32 weeks of pregnancy. Antibiotic use includes, Metronidazole if patient asymptomatic but with significant bacterial vaginosis, antibiotics if asymptomatic but significant bacteremia and antibiotics for preterm premature rupture of membrane.

Woman with leakage for fluid per vaginum and meconium stained liquor at weeks of gestation. Most likely organism causing infection would be Listeria monocytogenes.

Interventions recommended in active management of 3rd stage of labour includes administered of uterotonic within 1 minute of delivery, gentle massage of uterus and controlled cord traction and not recommended is immediate clamping, cutting and ligation of cord.

Nasopharyngeal carcinoma has bimodal age distribution, IgA antibody to EBV is observed and squamous cell carcinoma is most common histological subtype.

Most common site of CSF leak is fovea ethmoidalis, beta 2 transferrin estimation is highly specific for diagnosis of CSF leak and Fluorescein dye can be used intrathecally for diagnosis of site of leak.

Structures seen on bronchoscopy includes Trachea, Vocal cords and 1st segmental division of bronchi.

Child with stridor, barking cough, difficulty in breathing since 2-3 days, fever and elevated leukocyte count. Then subepiglottic stenosis and hypopharyngeal dilatation may be seen on X-ray, boys are more commonly affected than girls and symptoms are predominantly caused by involvement of subglottis.

Orthopaedics

Lateral meniscus covers more tibial articular surface than lateral, medial meniscus is more commonly injured than lateral and Menisci are predominantly made up of Type I collagen.

Changes seen in articular cartilage with aging includes total proteoglycan content is decreased, synthesis of proteoglycans is decreased and total water content of cartilage is decreased.

Metal on Metal articulation should be avoided in Young female.

Patient developed breathlessness and chest pain on 2nd postoperative day after a total hip replacement. Echocardiography showed right ventricular dilatation and tricuspid regurgitation. Most likely diagnosis is Pulmonary embolism.

17-year-old with acne has been taking a drug for las 2 years, now presents with blue black pigmentation of nails. Likely cause is Minocycline.

Treatment of erythematous rash with multiple pus lakes in a pregnant woman is Corticosteroids.

PAS is used to study fungal morphology in tissue sections.

Anaesthesia

Patient with bilirubin 8 mg/dL and serum creatinine 1.9 mg/dL is planned for surgery. Muscle relaxant of choice in this patient is Atracurium.

For neuromuscular blockade produced by succinylcholine there is no fade on train of four stimulation, no post tetanic facilitation and train of four ratio >0.4.

25-year-old overweight woman given fentanyl-pancuronium anaesthesia for surgery. After surgery and extubation she had limited movement of upper body and chest wall in recovery, she was conscious, alert but voluntary respiratory effort was limited, BP and HR normal. Likely diagnosis is Pulmonary embolism.

27-year-old woman with acute abdominal pain, laparotomy done, speedy intubation performed but after intubation breath sounds were observed to be decreased on left side and high end tidal CO2 was recorded. Likely diagnosis is Endobronchial intubation.

60-year-old had undergone cardiac bypass 2 days back, started forgetting things and was not able to recall names and phone numbers of his relatives. Probable diagnosis is Cognitive dysfunction.

Alcoholic paranoia is associated with fixed delusions.

60-year-old thinks he had committed sins throughout his life, is depressed and has considered committing suicide but has not through hot to go about it. He had also attended sessions of spiritual guru. He is not convinced by his wife that he has lead a pious life. He doesn’t want to hear anything on contrary. Treatment should be antipsychotic + antidepressant.

30-year-old man since 2 months suspects that his wife is having affair with his boss, his friend is also involved from abroad and is providing technology support and people talk about him. His friend tried to convince him but he is not. Most likely diagnosis is Persistent delusional disorder.

25-year-old woman with sadness, palpitations, loss of appetite and insomnia. No complaints of hopelessness, suicidal thoughts and no past h/o any precipitating event and otherwise normal life and behaviour. Most probable diagnosis is generalized anxiety disorder (GAD).

Patient in emergency with self-harm and indicates suicidal intent. Condition that does not warrant an immediate specialist assessment is acute alcohol intoxication.

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